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Scope of Services

Charge Capture

Capturing charges properly is a critical process to providers. It drives contract negotiation, billing, and cost containment initiatives. Proper charge capture is a necessary step in compliant and patient friendly billing.

Charge Description Master (CDM) Services

PCS' CDM services verify the accuracy and completeness of itemized charges within the hospital's CDM, and decrease potential exposure to compliance issues. Providers can select from a variety of CDM services:

  • Immediate Desk-top Updates
  • Quarterly Maintenance Agreements
  • Comprehensive On-site Reviews
  • On-site installation of proprietary CDM analytical tool
Clinical Documentation

The key to quality patient care and appropriate reimbursement is complete and specific clinical documentation. The translation of clinical documentation to coded data is never a simple task. Whether services are acute care, rehabilitation or psychiatry, most facilities have opportunities for documentation improvement.

Coding Reviews

PCS' coding and documentation reviews identify coding and compliance errors by screening and reviewing both inpatient and outpatient claims and medical records. By assigning the proper APC (Medicare) and DRG (Medicare & Non-Medicare) codes to a patient record, our clients can expect these results:

  • Improved Revenue and Profitability
  • Reduced Operation Costs
  • Decreased Compliance Exposure
Compliance

Today's healthcare providers face a dizzying array of new regulations and increased enforcement actions designed to combat fraud and abuse. As federal and state authorities multiply their efforts to scrutinize billing, it has never been more important for providers to identify areas of compliance weakness and develop solutions before these problems multiply.

Education & Training

PCS regularly provides educational programs for healthcare providers and coders including on-site and off-site workshops, teleconferences, and web conferences. All of our educational services offer the most up-to-date information available and frequently include case studies based on our hands-on experience.

Inpatient CMI Improvement

Inpatient services account for the largest portion of hospital costs and related reimbursement. PCS has a proven track record assisting acute facilities increase their CMI and revenue through improved clinical documentation and compliance. Communication becomes transparent when physicians and coders, working as a team, understand what is needed to reach new heights. Additionally, Sentinel InpatientTM offers a way for your facility to identify opportunities and issues on a continuous basis.

Rebilling Engagements

PCS' services include the rebilling of paid claims for a hospital to correct errors or omissions in the coding of a patient record to the insurance companies. Our clients' experiences with correct reporting have these results:

  • Identified Billing Errors and Omissions to correct on an ongoing basis
  • Improved Compliance, and
  • Significant Revenue Opportunities
Recovery Audit Contractor (RAC)

Contending with this new regulatory entity requires a comprehensive, team-based approach. Our team has:

  • Credentialed coders and compliance professionals who will work closely with your RAC team
  • First hand experience helping many healthcare providers with RAC during the demonstration project
  • Success built on delivering measurable solutions to today's healthcare challenges
Reimbursement Analysis, Cost Report Reviews & Rate Appeals

PCS' reimbursement analysis services are designed to protect and enhance the client's bottom line by recovering full payment through the following services:

  • Disproportionate Share Adjustment (DSH)
  • Medicare and Medicaid Rate Review and Appeals
  • Third Party Reimbursement and Cost Report Preparation and Analysis
Regulatory Support

Healthcare providers operate in a complex financial environment. They must be fluent in multiple coding methodologies (ICD-9-CM, HCPCS, CPT-4) and comply with different and sometimes conflicting third party payer regulations...all of which is constantly changing. Making sense of it all is easier with PCS on your side.

SentinelTM Product Suite

Choose from or use together - SentinelTM CDM, SentinelTM Outpatient and SentinelTM Inpatient.  PCS offers healthcare providers a web-based tool for comprehensive revenue cycle management. In addition, each SentinelTM product can be outsourced to save you time.  The underlying logic of SentinelTM is based on our extensive experience assisting hospitals to identify and correct coding, charging, and billing inaccuracies. SentinelTM prioritizes each edit by the likelihood of change and expected fiscal impact, thereby enabling users to easily focus on those issues with significant compliance or potential fiscal impact.

Strategic Pricing & Charge Analysis Services

PCS' Pricing and Charge Analysis services examine existing pricing and charge structures to maintain a competitive, rational, and sustainable pricing model to assure appropriate reimbursement across all payers. Our engagements are designed to take into account market value, competitive pricing, and corresponding reimbursement-related issues.




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Provider Consulting Solutions, Inc.